| NPI | 1922194307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS23514) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 4857) |
| 1041C0700X Social Worker, Clinical (Licence: CO 987020) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2011-11-18 |